Kingsway Manor provides permanent housing with supportive services for 31 persistently homeless individuals who have severe mental disorders. It opened in October, 2004, and a second permanent housing program serving an additional 30 clients opened six months later. The Emerald Development and Economic Network, Inc. (EDEN), a vital non-profit housing development organization, is a partner in both programs. Kingsway Manor is in Cleveland's Tremont neighborhood.

These programs provide permanent housing with intensive treatment and supportive services for adults who had been persistently homeless and without treatment. Many homeless adults with schizophrenic, schizoaffective, or other psychotic or mood disorders do not consistently participate in mental health and supportive services. Failure to obtain treatment can lead to disorganized thinking and conduct that is influenced by delusional beliefs, hallucinatory experiences, cognitive distortions, and social misperceptions. This new permanent housing program is designed to ensure that clients participate in the services they need to stay healthy and live independently in their own apartment.

Chronic and severe mental disorders that are untreated are formidable obstacles to permanent housing, because they contribute to disorganized conduct, and marked deterioration in critical social and functional skills. Daily living skills – the ability to shop, to cook and clean, to maintain health and personal hygiene - that successful placement in permanent housing requires is often absent in the persons served by this project. Substance abuse among persons with mental illness makes homelessness even more likely. The effects of substance abuse often exacerbate the symptoms of mental illness, while the extent of substance use often leads to illegal behavior that may violate rental agreements. Both mental disorders and substance use disorders may lead to the unwise management of income, leaving rent and utilities unpaid.

To achieve and maintain permanent housing, these clients need a comprehensive and flexible array of psychiatric and supportive services. This program was designed to provide these services in a setting that would invite client participation in the services. The program also addresses one of the "service gaps" identified by the Office of Homeless Services.

The Clubhouse model of psychosocial rehabilitation provides the structure for the supportive and educational services provided by this program. This model encourages residents to work together and mutually support each other as they learn new skills. Program staff facilitate regular Clubhouse meetings with participants to plan activities, discuss issues, and resolve problems. Through these meetings, participants make decisions about the operation of the program.

Case managers work with clients to identify strengths, resources, and needs, select the services to best meet these needs, and maintain participation in these services. Case managers and clients establish service goals, and formulate individualized service plans that guide clients in the achievement of these goals. Case managers and other staff members provide life skills training, helping clients to acquire or relearn the basic skills needed for successful self-sufficiency. Among these skills are maintenance of personal hygiene; food selection, shopping, preparation, and storage; use of public transportation; management of their income; protection of health; and skills in the negotiation and management of interpersonal demands.

Psychiatric services are a critical component of the programs. Clients participate in a comprehensive assessment of their mental illness and functional capacity. Distorted perceptions, disorganized conduct, and skills deficits that are may have been first attributed solely to a mental illness are often later seen to be related to co-existent alcohol and drug use and behavior patterns learned to cope with prolonged homelessness and repeated victimizations. Upon completion of an assessment, clients work with the psychiatrist and case manager to create and implement a recovery plan for the achievement of self-sufficiency. A nurse conducts a physical health assessment, and provides health services to address any medical problems associated with prolonged homelessness and poor nutrition, such as diabetes, hypertension, and respiratory disorders.

Supportive services offered by these programs are both comprehensive and integrated. They are comprehensive because they address the specific symptoms and features of mental disorders and substance-use disorders, as well as the need to develop daily living skills, interpersonal relationships, and community supports. The services are integrated because service providers are part of a service team that works collaboratively and in a coordinated manner.

Kathryn Kazol is Executive Director of Emerald Economic and Development Network, Inc. (EDEN), a non-profit housing development corporation. EDEN and MHS are collaborative partners in this and other homeless assistance programs in Cuyahoga County, Ohio.

To learn about other MHS programs providing coordinated care
for homeless persons with disabilities, click on the links below.

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It was most recently updated on 14 May 2009.
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